HomeMy WebLinkAboutWS 34 - CHANGE OF CONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 LOT 34
(772) 4624553 FAX 4624578
CHANGI OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR —Change of Contractor is to be sigled and notarized by the property owner,
and the new contractor of record for the current permit. A new permit application must also be completed with new
contractor information and signature. A new Notice of Commencement must be filed in the new contractor's name
for job values greater than $2,500 ($71500 if A/C Change -out). A recorded copy must be submitted prior to
commencing any work. There is a $50.00 fee for the Change of Contractor.
xxx CHANGE OF SUBCONTRACTOR — Subcontractor changes are to be completed by the general contractor.
The new subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub -
Contractor.
CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date:
12/8/2021
Site Address: 5121 ARMINA PLACE
Permit Number: SLC 2104-0693
FAMILY AIR, INC State License SLC License
Original GC, subcontractor oroowner/builder
by,g)STMDM AJLA; L11YItb11 o State Licensr. AOt�;�? I SLC License
New GC, subcontractSr
Reason for Cancellation Non -Performance
The undersigned does hereby agree to indemnify and hold harmless
costs, fees or dama es arising from any and all claims of action for
contractor/su ntrac r aneethatt lsafpermit. A permit can—n(ll
SIGNATURE OWNER owneribuilder) Sid
PRINT N n Borkenhagen PR
State of Florida, County of St. Lucie County
The following instmment was acknowledged beforo melhis
24 day of June 0?J by
Kevin or
has produce 1'•R•�t'. ;;q os ��pp� ATHLEEN F. INGERSOLL
rnYCOMMINIONIHH182277
ember3,2026
Signature of Notary .•' oi�(t°HateBprWad Tfuu NolUy puNlo Undamuen;
Revised 04/15/16
�, agents and employees frog
as a result of this change of
new CC, es applicable)
C. Lindstrom
State of Florida, County ofSt. Lucie County
The following iustmment was acknowledged before me this
r+ day of +�+ 2021 ,by +eyc.um.u�
wh ersonell awn to
me or o h, pro uced�_as IDQI I
Sig naturclooff�Nlotary lily DateC
LISAG1885
,: MY COMMISSION tt G 2022165
�1ico EXPIRES:Aptil22,
Bonded Thm Na1ory Pubib Ulde Wd1e re